Políticas públicas de prevenção à automutilação e ao suicídio - Previdência - 07/04/26

Name: Políticas públicas de prevenção à automutilação e ao suicídio - Previdência - 07/04/26
Uploaded: 2026-04-07T21:00:53.000Z
Duration: 3 h 18 min 51 s

Opening of the Public Hearing on Law 13.819/2019

Introduction to the Meeting

The public hearing is officially opened to discuss the challenges in applying Law 13.819/2019, aimed at preventing self-harm and suicide. This meeting was called under requirement 9 of 2026 by the speaker, approved by the committee on social assistance and family.

Broadcasting Information

The session is being broadcast live on YouTube and the Chamber of Deputies' portal, with an implicit authorization for publication unless stated otherwise. Participants' speeches may be recorded indefinitely as per constitutional provisions.

Structure of Presentations

Each invited speaker will have a total of 10 minutes for their presentation without interruptions; however, registered deputies can ask questions strictly related to the topic for up to 3 minutes each, with equal time allowed for responses.

Objectives and Context of Discussion

Focus on Law Effectiveness

The primary goal is to analyze whether Law 13.819 has effectively transitioned from theory into practice since its enactment seven years ago, particularly in light of alarming statistics regarding self-harm and suicide among children and adolescents.

Rising Concerns

There is a notable increase in self-harm and suicide rates among young individuals, including concerning trends among men, indicating a broader societal issue that necessitates urgent discussion about legislative effectiveness in prevention efforts.

Call for Expert Insights

Invitation to Experts

The speaker expresses eagerness to hear from experts like Alexandre Augusto Rodrigues from the Ministry of Education, emphasizing collaborative dialogue as essential for understanding gaps in current preventive measures against self-harm and suicide behaviors. Each expert will present via videoconference with limited time allocated due to shared representation from their department.

Presentation by Alexandre Augusto Rodrigues

Acknowledgment and Greetings

Alexandre begins his presentation by acknowledging attendees and expressing gratitude for participating in this critical discussion about implementing Law 13.819 as a public policy aimed at mental health promotion and prevention strategies against self-harm and suicide within educational contexts.

Overview of Legislative Framework

He outlines that the law establishes national policies focused on mental health promotion while requiring intersectoral collaboration between education, health services, and social assistance systems—highlighting that effective implementation cannot be centralized solely within schools but must involve broader community engagement efforts.

Challenges Identified in Implementation

Coordination Among Sectors

A significant challenge identified is ensuring coordinated efforts across various sectors (education, health care, social services), as schools alone lack sufficient resources or training to address psychological distress effectively without external support systems integrated into their operations.

Importance of Professional Training

Emphasizing professional development within educational settings is crucial; educators need training aligned with human rights education principles that foster safe environments conducive to addressing students' mental health needs adequately while promoting diversity acceptance within school communities.

Education and Human Rights: Addressing Violence in Schools

Overview of Educational Framework

The curriculum structure for basic education is outlined in Article 26, emphasizing the importance of human rights education as a foundational element for fostering a culture of care and belonging.

The Ministry of Education, through SECADI, has expanded ongoing training initiatives aimed at combating violence and promoting health within school environments.

Challenges in Educational Materials

There are significant challenges in producing responsible educational materials that address violence without trivializing the issue or using inappropriate approaches.

The contemporary context, characterized by digital technologies and issues like cyberbullying, complicates these challenges and necessitates a critical approach to digital education and socio-emotional skills development.

Importance of Human Rights Education

The effectiveness of the discussed law in education relies on establishing schools as safe spaces for protecting rights and creating meaningful life experiences.

A national plan for human rights education has been in place since 2003, supported by national guidelines from the National Council of Education, covering both basic and higher education.

Collective Responsibility in Mental Health

Addressing self-harm and suicide prevention is a collective responsibility; education plays a crucial role in affirming life, care, and dignity for every student and educator.

Integrating Psychosocial Attention in Education

Role of the Ministry of Education

Alexander continues discussing initiatives from the Basic Education Secretariat within the Ministry of Education focused on psychosocial attention.

He highlights his position related to transversal themes within the curriculum, particularly linking health with education through programs like "Saúde na Escola."

Program "Saúde na Escola"

The "Saúde na Escola" program has been established since 2007 through an inter-ministerial decree between Health and Education Ministries, achieving historical participation rates among Brazilian municipalities.

This program serves as a vital connection between health services and schools while prioritizing mental health topics during its latest implementation cycle.

Legislative Framework for Mental Health

Efforts are underway to implement Law No. 13935/2019 concerning mental health support in schools, which includes hiring psychologists and social workers.

In collaboration with other stakeholders, there is ongoing work towards implementing Law No. 14819/2024 that establishes national policies for psychosocial attention within school communities.

Mental Health Promotion and School Environment

Importance of Mental Health in Adolescence

The discussion emphasizes the critical role of mental health promotion, particularly during adolescence, which is a pivotal period for emotional and physical transitions.

Acknowledges the establishment of a working group focused on improving school climate and relationships, recognizing the unique challenges faced by students transitioning from childhood to adolescence.

Initiatives for Improving School Climate

Highlights the creation of a national guide aimed at enhancing school climate based on research conducted with school administrators.

Discusses technical support provided for implementing Law No. 15100/2025, which limits electronic device usage in schools due to its correlation with mental health issues among adolescents.

Research and Evaluation Efforts

Mentions ongoing national research assessing the impacts of the aforementioned law one year post-implementation to understand its effects on student well-being.

Introduces the "Escola que Protege" program focusing on violence prevention within schools as part of an interconnected approach to psychosocial care.

Challenges in Addressing Youth Self-Harm and Suicide

Rising Rates of Self-Harm and Suicide

Vinícius Batista Vieira addresses increasing rates of self-harm and suicide among youth, emphasizing its urgency as a public health concern.

Cites recent findings from MEC's "Pense" survey that highlight mental health issues as significant problems affecting children and adolescents.

Implementation Challenges

Discusses challenges in implementing laws aimed at preventing self-harm and suicide while strengthening healthcare networks to address these issues effectively.

Collaborative Efforts for Prevention

Outlines efforts by the Ministry of Health under decree 10.225 to establish a management committee focused on national policies for self-harm prevention.

Strengthening Psychosocial Care Networks

Monitoring and Research Partnerships

Describes partnerships with various institutions to monitor incidents of self-harm and suicide attempts while fostering professional training for effective reporting.

Expanding Mental Health Services

Emphasizes ongoing initiatives since 2023 aimed at expanding access to mental health services across municipalities, including funding new service openings.

Focused Support Services

Highlights specific services like CAPS (Centros de Atenção Psicossocial), designed for severe cases requiring specialized attention within community settings.

Mental Health Promotion Strategies

Importance of Intersectoral Actions

Emphasizes the need for mental health promotion through intersectoral actions involving art, culture, leisure, and community engagement to enhance overall mental well-being.

Hospitalization and Care Quality

Discusses the establishment of mental health beds in general hospitals for severe cases requiring hospitalization, aiming for more humane and higher-quality intensive care.

Education and Training Initiatives

Highlights various ongoing educational strategies for primary care professionals, including a course titled "Nós na Rede" with 49,000 available slots nationwide. Also mentions suicide prevention training developed by UNIFESP.

Research and Support Structures

Mentions the upcoming National Mental Health Survey and institutional support provided to states and municipalities to strengthen local care networks aligned with human rights principles.

Focus on Children and Adolescents' Mental Health

Reiterates the commitment to enhancing mental health services for children and adolescents, including collaboration with education ministries to implement national psychosocial policies in schools.

Enhancing Community Engagement

Activities for Youth Engagement

Describes initiatives aimed at promoting mental health among children through community centers that offer activities related to art, culture, leisure, fostering social interaction.

Improving Mental Health Services Infrastructure

Discusses efforts to improve normative frameworks and clinical structures within youth mental health facilities while considering 24-hour psychosocial support centers.

Reviving National Forums on Child Mental Health

Resumption of National Forum

Announces the revival of the National Forum on Child and Adolescent Mental Health after a decade-long hiatus as a crucial tool for organized intersectoral management.

Regional Forums Initiative

Details recent regional forums held in March aimed at creating effective intersectoral policies regarding child mental health issues across different regions.

Suicide Prevention Framework

WHO Guidelines on Suicide Prevention

Outlines four key directives from WHO regarding suicide prevention: limiting access to lethal means, responsible media coverage, developing socio-emotional skills in youth, and early identification of suicidal behaviors.

Brazil's Commitment Challenges

Critiques Brazil's progress as a signatory of global pacts aimed at reducing suicide rates due to rising statistics contrary to established goals.

Understanding the Multifaceted Nature of Suicide

The Multisectoral Approach to Suicide Prevention

Suicide is a multifactorial phenomenon that requires intervention from various sectors, not just health services.

There is an increasing concern regarding suicide rates among both youth and elderly populations, necessitating a broader analysis of age demographics.

Challenges in Implementation of Existing Laws

A critical evaluation is needed on how laws enacted seven years ago have been implemented, especially in small to medium-sized municipalities where resources may be limited.

Many essential services for suicide prevention cannot be established in smaller municipalities due to existing regulations and resource constraints.

Medicalization and Societal Factors

The medicalization of life has led society to seek diagnoses for children and adolescents, potentially masking underlying issues rather than addressing them directly.

High levels of social inequality contribute to feelings of hopelessness and lack of purpose among individuals, which are significant risk factors for suicide.

Public Health Perspective on Suicide

Suicide should be recognized as a public health issue, requiring comprehensive strategies beyond just healthcare responses from the Ministry of Health. This includes addressing societal factors contributing to mental health crises.

There is a tendency to view suicidal behavior merely as a medical condition that can be treated with medication, which oversimplifies the complexity of the issue. This perspective risks reducing effective interventions to mere pharmacological solutions.

Role of Civil Society and Government Responsibility

There is a call for greater responsibility from civil society organizations in addressing suicide prevention; however, substantial support must come from government at all levels (federal, state, local).

Since the law's enactment, there has been insufficient funding allocated for hiring professionals or establishing necessary services aimed at preventing suicide and promoting mental well-being within communities.

Intersectoral Collaboration Needed

Effective strategies require collaboration across multiple sectors including health care providers, community leaders, religious organizations, and public safety officials to create supportive environments for vulnerable populations.

Addressing suicide also involves considering various social determinants such as gender identity, economic status, sexual orientation, and race—factors that significantly influence mental health outcomes.

Understanding Suicidal Behavior Beyond Disease Models

Suicidal behavior should not solely be classified as a disease but understood as both a psychological symptom and a reflection of broader social issues; this understanding remains underrepresented within public health frameworks today.

There exists significant stigma surrounding suicidal behavior among professionals who may not feel equipped or trained adequately to address these complex issues effectively within their practice settings.

Gaps in Youth Mental Health Services

There is an alarming shortage of specialized mental health services (CAPS) available for youth across Brazil; this gap highlights urgent needs within child and adolescent mental health care systems nationwide.

Next Steps: Implementing Effective Solutions

Call for Action

Emphasis on developing actionable plans based on WHO guidelines while ensuring local-level implementation aligns with national policies remains crucial moving forward.

This concludes my initial considerations on the topic; I am open for further discussion towards collective solutions moving ahead!

Discussion on Suicide Prevention and Mental Health

Introduction of Key Participants

The speaker acknowledges key figures in the discussion, including Alexandre Augusto Rodrigues from the Ministry of Education, Herastro Fortes Mendonça from the Ministry of Education's General Coordination for Educational Policies and Human Rights, Vinícius Batista Vieira from mental health services, and Cristiane Nogueira from the Federal Council of Psychology.

Personal Experience with Suicide Prevention

The speaker shares their background as a former Secretary of Health in Rio Grande do Sul, where they initiated a violence prevention program addressing homicide, traffic violence, and suicide.

Emphasizes that Rio Grande do Sul has a significantly higher suicide rate than the national average, prompting urgent action to address this issue.

Understanding Causes of Suicide

Discusses how individuals typically do not consider suicide when they are happy; rather, it often occurs during severe mood disorders like depression.

Notes that certain ethnic groups in specific regions exhibit higher suicide rates; for example, descendants of Pomeranian colonists show increased vulnerability.

Early Detection and Intervention Strategies

Highlights efforts to detect early signs of mood disorders among adolescents who experience rapid emotional fluctuations.

Describes training healthcare professionals to recognize subtle symptoms of severe depression and other mood disorders that can lead to suicidal behavior.

Impactful Results from Interventions

Reports a 17% reduction in suicide rates over two years due to proactive monitoring and treatment engagement strategies implemented by trained health teams.

Stresses that suicidal behavior is often linked to underlying psychiatric conditions rather than solely social issues; understanding individual reactions to frustration is crucial.

Importance of School-Based Detection

Warns that early signs such as self-harm or suicidal thoughts must be taken seriously; these indicators require immediate attention.

Advocates for mandatory reporting laws in schools to ensure teachers are equipped to identify at-risk students without needing diagnostic skills.

Mental Health and Suicide Prevention: Key Insights

Importance of Training in Mental Health Detection

There is a need for family doctors to be trained in identifying mood disorders, as not all are equipped to detect psychiatric issues.

Schools and health posts must have systems in place to notify and track individuals with significant mood disorders, ensuring proper follow-up and support.

Legislative Framework for Mental Health

The law addressing mental health issues aims to tackle social problems but recognizes that it cannot solve all societal issues related to suicide prevention.

Suicide rates are notably higher among the middle class rather than lower socioeconomic groups, indicating a need for targeted interventions.

Implementation Challenges

Emphasis on the necessity for ministries (Education, Health) to comply with existing laws regarding mental health notification and monitoring.

A call for action after seven years without effective implementation of the law highlights the urgency of addressing these mental health challenges.

Diagnostic Issues in Public Health Policy

The lack of accurate diagnostics hampers the development of effective public policies; without data, responses remain reactive rather than proactive.

The absence of early detection leads to an increase in cases without reducing existing ones, complicating efforts to manage mental health crises.

Early Detection and Prevention Strategies

Early diagnosis is crucial for preventive measures; without it, suicides may only be recognized post-factum when it's too late.

Addressing self-harm behaviors among youth is essential; failing to intervene early can lead to tragic outcomes later on.

Educational Initiatives

Questions raised about whether teachers are being trained adequately to handle self-harm and suicidal ideation among students.

Introduction of online courses by the Ministry of Education since 2022 aimed at equipping educators with skills necessary for supporting students' mental health.

Mental Health Promotion for Educators

Overview of Mental Health Courses for Teachers

The courses aim to equip educators with methodologies and tools to address mental health issues in the classroom, focusing on identification, management, and care.

These programs strengthen the connection between health and education by emphasizing teachers' responsibilities in referring students to protective networks in severe cases.

The most accessed course is "Saúde Mental na Escola," which has garnered over 420,000 accesses since its launch in 2025, indicating high engagement from the educational workforce.

Collaboration with Child Mind Institute

Ongoing discussions with the renowned Child Mind Institute are aimed at developing a new course focused on crisis management within classrooms, set to launch next semester.

This upcoming course will enhance teachers' literacy in mental health, providing critical skills for managing serious mental health issues.

Participation and Certification Process

Questions arise regarding how teachers participate in these courses—whether they are voluntary or mandated by the Ministry of Education—and how their involvement is monitored.

Avamec's courses provide certification upon completion; tracking data allows monitoring of who accesses and completes these courses effectively.

Accessibility of Courses

Most Avamec courses are self-instructed, allowing public and private school teachers to access them at their convenience without fixed schedules due to diverse school timetables.

Course offerings range from short 30-hour free courses to more extensive 180-hour specialization programs available online.

Recommendations for Teacher Training

A suggestion is made for a potential internal recommendation from the Ministry of Education requiring teacher participation in mental health training given rising concerns about self-harm and suicide among students.

Emphasizing that schools serve as crucial diagnostic points where teachers can identify early signs of distress among students highlights the need for structured training initiatives.

Discussion on Mandatory Notification in Education

Importance of Mandatory Notification

The speaker emphasizes the necessity of mandatory notification by schools regarding risks, highlighting that without it, public policy becomes ineffective.

Concerns are raised about the lack of implementation of this mandatory notification, suggesting that many potential suicides could have been prevented if proper notifications were made.

Responsibility and Implementation

The responsibility for notifying about mental health issues lies with schools, marking a significant shift as previous laws focused on health posts rather than educational institutions.

Health posts are required to notify authorities about infectious diseases; similarly, schools must ensure they report mental health concerns effectively.

Role of the Ministry of Education (MEC)

The MEC is urged to take more responsibility in ensuring effective notification processes within schools.

There is recognition that while tools for prevention exist, teachers need specific training and support to handle these situations effectively.

Teacher Training and Support

Teachers play a crucial role in early detection of mental health issues; thus, their training is essential for saving lives.

The speaker praises existing courses available for educators but stresses the need for proactive measures to ensure participation and application in real-world scenarios.

Legal Framework and Autonomy

Discussion highlights that under current laws, MEC cannot enforce changes directly upon educational systems due to constitutional limitations.

Policies from MEC can only be implemented if local education systems voluntarily adopt them; thus, collaboration is key.

Professional Development and Accountability

While MEC promotes professional development through courses, it cannot mandate participation; instead, it focuses on creating an environment conducive to voluntary engagement.

Educators are legally obligated to report any observed violence or self-harm among students; failure to do so can result in criminal liability.

Legislative Considerations

The importance of legislative frameworks is emphasized; if current laws are deemed insufficient, there should be efforts to improve them collaboratively with Congress.

Discussion on Educational Legislation and Mental Health

Legislative Improvements for Education

The speaker emphasizes the need for improvements in laws related to education, suggesting the creation of new laws and amendments to the Constitution to address current issues.

A specific decree is mentioned that mandates training for school managers, teachers, and communities on preventing self-harm and suicide, highlighting its importance in educational settings.

Community Involvement in Training

The speaker advocates for utilizing existing resources from the decree to promote voluntary training programs within schools, enhancing community engagement in mental health awareness.

There is a call for collaboration between lawmakers and educational authorities to form a working group aimed at addressing self-harm and suicide prevention effectively.

Addressing Youth Suicide Epidemic

The discussion shifts towards the alarming rates of youth suicides in Brazil, stressing that this issue is often underreported due to societal taboos.

The necessity of proper notification systems regarding mental health crises is highlighted; healthcare authorities must be informed about potential risks as mandated by law.

Legal Responsibilities and Social Accountability

The speaker argues that all stakeholders have a social responsibility to protect life, emphasizing that self-harm should be treated as a serious issue requiring immediate action.

It’s asserted that laws passed by Congress must be respected and enforced; there should not be selective compliance based on public opinion or bureaucratic challenges.

Call for Action from Institutions

The need for institutions like the Ministry of Health and Education to fulfill their roles in enforcing these laws is stressed; they must ensure proper reporting mechanisms are established.

A strong message concludes with an insistence on accountability from educators when identifying cases of self-harm among students, reinforcing the urgency of adhering to legal obligations.

Discussion on Notification and Suicide Prevention

Importance of Notification in Saving Lives

The speaker emphasizes the critical role of notification in suicide prevention, stating that without data from notifications, effective prevention strategies cannot be developed.

They argue that failing to prevent suicides leads to a reactive approach, which is insufficient as it only addresses the aftermath rather than preventing occurrences.

Clarification on Democratic Management

A participant requests clarification regarding previous statements about democratic management, asserting they did not claim it undermines legal respect. Instead, they highlight its role in organizing educational systems effectively.

The speaker insists that democratic management should enhance compliance with laws rather than contradict them.

Legislative Reference for Notifications

Mention of Law 15.231 from 2025 is made, which mandates notifications to the Tutelary Council concerning health issues related to suicide and mental health. This law underscores the necessity of such notifications for proper intervention.

Training and Capacity Building for Health Agents

Training Programs for Health Agents

Discussion revolves around whether public health agents receive training similar to education professionals; it’s noted that their training programs are distinct but essential for their roles in community health.

The Ministry of Health provides specific training focused on mental health tailored for community health workers through various formats including self-instructional courses at NASUS (Universidade do SUS).

Course Participation Dynamics

It is clarified that participation in these courses often depends on municipal adherence and recommendations regarding which agents should attend based on current needs or situations within communities.

Telehealth Initiatives in Mental Health

Implementation of Telehealth Services

Current efforts include piloting telehealth services specifically aimed at women experiencing violence; initial trials are being conducted in cities like Recife and Rio de Janeiro with plans for broader implementation later this year.

The aim is to understand how these telehealth services can effectively meet the needs of women while gradually expanding access across larger populations throughout Brazil.

Future Directions for Telehealth Services

There remains an acknowledgment that while there are initiatives underway, specific telehealth support addressing self-harm and suicide has yet to be fully realized or implemented within existing frameworks targeting women's mental health needs.

Discussion on Mental Health and Suicide Prevention

Final Considerations by Dr. Cristiane Nogueira

Dr. Nogueira emphasizes the complexity of the topic and notes that public policy implementation is lagging behind, questioning the effectiveness of laws if they do not lead to concrete actions for the population.

She highlights the need for regulation in social media, particularly concerning youth, as unregulated content can contribute to issues like suicide through a phenomenon known as "Werther effect."

The importance of local networks in mental health support is discussed, referencing successful intersectoral committees that have been established and recognized globally for their positive outcomes.

Dr. Nogueira stresses that professionals working in mental health must be adequately trained to address suicide prevention and self-harm effectively, advocating for compulsory reporting of such cases.

She concludes with a call to action for professionals in education and health sectors to engage actively with these issues, emphasizing personal commitment over formal plans.

Final Remarks by Dr. Vinícius Batista Vieira

Dr. Vieira expresses gratitude for the opportunity to participate and underscores the Ministry of Health's efforts to collaborate more closely with educational institutions on mental health matters within schools.

He acknowledges the delicate nature of integrating health care into educational settings while stressing its necessity, especially regarding notification processes related to mental health issues among students.

Highlighting that mental disorders are multifactorial, he points out that cultural and familial factors are just as significant as genetic ones in understanding childhood and adolescent mental health challenges.

He advocates for structural improvements within society that could enhance family relationships and reduce work-related stressors affecting parents' ability to connect with their children effectively.

Dr. Vieira concludes by addressing the shortage of child psychiatrists in Brazil, indicating ongoing efforts to encourage medical students toward specialization in psychiatry as a priority area for improvement in mental healthcare services.

Discussion on Mental Health and Education Policies

Importance of Psychiatry Residencies

The speaker emphasizes the need for increased psychiatry residency programs due to a high demand for mental health professionals, particularly in Bahia.

Collaborative Efforts in Mental Health

Alexander Augusto discusses the complexity of mental health issues requiring strong theoretical, methodological, political, and technical investments. He highlights collaboration with various ministries to address these challenges effectively.

Personal Experience in Mental Health Services

Alexander shares his background as a psychologist who has worked directly in vulnerable communities, acknowledging the significant challenges faced by mental health professionals in such environments.

Commitment from the Ministry of Education

The Ministry of Education is committed to addressing mental health issues through internal and intersectoral discussions aimed at improving educational policies related to mental well-being.

Educational Environment as a Safe Space

Eastos stresses that schools should be places of safety and protection where individuals feel welcomed. He advocates for creating an environment rooted in love and respect within educational settings.

Legal Framework for Human Rights Education

Emphasizing Article 26, paragraph 9 of the LDB, Eastos argues for integrating human rights education into school curricula as essential for fostering a culture of respect and protection against violence.

Culture of Respect Towards Human Rights

A culture that respects human rights is crucial for establishing safe school environments. This approach encourages educators to commit personally and professionally to combating issues like self-harm and suicide among students.

Collective Effort Against Self-Harm and Suicide

The discussion concludes with a call for collective action across Brazil to prevent self-harm and suicide, highlighting the importance of legislative efforts aimed at saving lives.